Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 54578 | TN |
N | 207XS0106X | Orthopaedic Hand Surgeon | 54578 | TN |
NPI | 1063730059 |
---|---|
Provider Name | Dr. Erik M Maryniw |
First Address | Goodlettsville, TN 37072-3132 |
Second Address | Hermitage, TN 37076-2054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2010 |
Last Update Date | 10/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6077815 | BCBS TN (01) | TN |
Q023065 | (05) | TN |